DNFB Reports: How to Turn Discharges into Cash Faster

Every CFO and revenue cycle leader knows this scenario. Census is stable, volumes look fine, but cash is soft and accounts receivable is creeping up. Denial rates are not dramatically worse, and front-end metrics look acceptable. When you dig into the details, you find the culprit: a silent build up in your Discharged Not Final Billed (DNFB) report.

DNFB is not just a middle-office annoyance. It is accumulated earned revenue that has not yet entered the claim pipeline. The longer it sits, the more it distorts KPIs, increases timely filing risk, and starves your organization of working capital.

This article walks through how to treat DNFB as an executive level performance indicator. You will see how to structure your DNFB report, interpret what it tells you, and redesign workflows so that discharges flow reliably into clean, timely claims.

Why DNFB Should Be Treated as a Core Financial KPI

Many organizations track DNFB as a HIM or coding metric. That approach keeps DNFB buried in the middle of the revenue cycle instead of elevating it as a core financial indicator on equal footing with Days in AR or cash collections.

From a finance perspective, DNFB represents booked but unbilled revenue. Once the patient is discharged, nearly all variable costs have already been incurred. What remains is the conversion of that encounter into a claim and then into cash. Any delay in that conversion is a direct hit on cash flow.

For high volume organizations, the impact becomes material very quickly. Consider a hospital that averages 1.5 million dollars in gross charges per day. If the average DNFB age is 6 days, you are sitting on roughly 9 million dollars that has not even been submitted. Reducing that to 3 days effectively releases 4.5 million dollars of near term cash capacity without adding a single new visit.

When you treat DNFB as a core KPI, several operational shifts should follow:

• Visibility at the top: DNFB dollars and DNFB days belong on the same dashboard as net cash, AR days, and denial rates, ideally segmented by facility, service line, and payer.

• Targets and thresholds: Executive leadership should define acceptable DNFB ranges by setting specific targets such as an overall DNFB of fewer than 4 days and tighter targets for high dollar service lines.

• Accountability across departments: DNFB is not only a coding or HIM problem. It is shared across providers, documentation, case management, IT, and billing operations. Ownership must be clearly defined by reason code, not simply by function.

Once you recognize DNFB as an early warning signal for cash and denial risk, your report transforms from a static list to a control panel for managing the speed and quality of billing.

How to Structure the DNFB Report So It Actually Drives Decisions

A DNFB listing that simply shows a list of accounts and discharge dates is useful at the analyst level but insufficient for executive decisions. To make the report operationally powerful, you must design it around four dimensions: age, value, cause, and risk.

Segment by Age and Financial Weight

Start by grouping DNFB accounts by age buckets and financial weight. Typical age buckets might be 0 to 2 days, 3 to 5 days, 6 to 10 days, 11 to 20 days, and greater than 20 days. Within each bucket, track both count of accounts and total gross and expected net revenue.

This structure answers key questions rapidly:

• Is the issue confined to normal processing lag in the 0 to 2 or 3 to 5 day buckets, or is there a meaningful backlog in older buckets?

• Are the dollars concentrated in a small number of complex, high value cases or spread widely across routine encounters?

Tag Every Account with a Primary DNFB Reason

Raw age and dollars are not enough. Each DNFB account should be tagged with a primary reason code that indicates why it is not yet billable. Common reason categories include:

• Incomplete provider documentation or unsigned orders.

• Pending physician query.

• Awaiting coding assignment.

• System editing or interface error (for example, failed charge interface).

• Pending external information (for example, outside lab or referring documentation).

• Held for internal review (for example, utilization review or complex case review).

When you view the DNFB report by reason code and age bucket, patterns become obvious. For instance, you may see that 70 percent of DNFB over 10 days is driven by missing operative notes in one surgical specialty. That is a very different problem than an overall coding capacity issue.

Highlight Time Sensitive and High Risk Accounts

Some accounts in DNFB represent routine, low dollar office visits that will resolve quickly. Others are high dollar, multi day stays that are approaching payer timely filing limits. The report must distinguish these categories visually.

Best practice is to flag accounts that are either:

• Above a defined dollar threshold for gross or expected net revenue.

• Within a defined window of the earliest payer timely filing limit (for example, within 45 days of the shortest limit).

These flagged accounts should appear at the top of summary views and be routed to a specific work queue for priority resolution.

By reengineering your DNFB report along these lines, you shift it from a long static listing to an analytic tool that can drive daily work lists, performance huddles, and executive review.

Root Causes of DNFB Backlog and How to Diagnose Them Systematically

High DNFB is not a single problem. It is the aggregate effect of many small delays at various points in the care and documentation process. To reduce DNFB sustainably, you must approach diagnosis with the same rigor you would apply to a clinical quality issue.

Use the “Five Whys” Root Cause Approach

For each major DNFB reason category, apply a structured root cause method. For example:

• Symptom: Orthopedic DNFB over 10 days is unusually high.

• Why? Many accounts are missing signed operative notes.

• Why? Surgeons complete dictated notes in the transcription system, but signatures are often delayed.

• Why? Surgeons are not receiving timely alerts that notes are ready for signature.

• Why? The EHR tasking workflow was never configured for that specialty’s template.

• Why? The template was created as a one off at go live and never updated into standard workflows.

In this example, the real fix is not simply sending more reminders. It involves EHR configuration, governance of documentation templates, and provider onboarding.

Map the DNFB Journey by Service Line

Different service lines have very different discharge to bill workflows. For example:

• Inpatient surgeries depend on anesthesia, operative notes, progress notes, and discharge summaries.

• Emergency department visits rely heavily on accurate diagnosis coding, level of service assignment, and timely provider signatures.

If you overlay DNFB reason data on these distinct workflows, you can quickly see which handoffs repeatedly fail. You may discover that case managers consistently close out discharges late over weekends, or that radiology reports are not interfacing reliably back to the EHR for certain modalities.

To keep the investigation grounded, pair analysts with operational leaders from nursing, physicians, and HIM. Walk through specific accounts, from discharge timestamp to the moment each required data element is available. Small bottlenecks often become obvious in these joint reviews.

Designing Workflows that Move Discharges to Billable Status Quickly

Once you understand why accounts sit in DNFB, you can design workflows that prevent delays instead of chasing them after the fact. The goal is straightforward: create a predictable path from discharge to claim generation with minimal variability.

Embed Documentation Requirements Upstream

The most effective way to reduce DNFB is to prevent documentation gaps at the source. That requires stronger alignment between clinical processes and revenue cycle requirements. Examples include:

• Configuring EHR order sets and note templates that capture required elements for coding without excessive free text, for example, laterality, type of procedure, and relevant comorbidities.

• Building discharge checklists that include completion of specific forms or notes before the patient physically leaves the unit, particularly for surgical and high acuity cases.

• Establishing clear service level expectations that discharge summaries are signed within a set number of hours, with dashboards that show compliance by provider.

Align Coding Capacity with Discharge Patterns

Even with perfect documentation, coding bottlenecks can quickly swell DNFB. To avoid this, match coding capacity with actual discharge patterns. Practical steps include:

• Analyzing discharge volume by day of week and time of day, then scheduling coders so that capacity peaks shortly after typical discharge peaks.

• Separating high complexity cases into specialized coder queues, so that routine encounters are not held up behind a small number of difficult charts.

• Using remote or flexible staffing models to absorb short term surges, such as seasonal volume increases or backlogs after system downtime.

Automate Routing and Alerts

Modern systems allow you to automate much of the DNFB workflow. For example:

• Automatically route cases with missing documentation to the responsible provider’s inbox, with aging indicators and escalation rules for items older than defined thresholds.

• Push high dollar or near timely filing limit accounts into priority work queues for HIM leads or denial prevention teams.

• Trigger notifications to service line leaders if DNFB metrics for their area cross pre defined limits, such as an increase in DNFB days by more than 1 day week over week.

The more the system orchestrates work routing, the less time staff spend manually searching for high risk items, and the more consistent your discharge to bill timing will become.

Key Metrics and Benchmarks for Ongoing DNFB Management

Redesigning workflows is only half the job. The other half is maintaining discipline with a consistent metric set that leadership and front line teams can understand easily. DNFB management should always include both lag and volume metrics.

Core DNFB Metrics to Track

At a minimum, track the following on a weekly and monthly basis:

• DNFB dollars outstanding: Total gross and estimated net revenue tied up in DNFB at a given cut off. Segment this by service line, facility, and primary payer category.

• Average DNFB days: Average age from discharge to billable status for accounts that are still unbilled, again segmented meaningfully.

• Percentage of DNFB older than defined thresholds: For example, percentage of DNFB dollars older than 7 days, 10 days, or 14 days.

• Distribution by reason code: Percent of DNFB dollars associated with each root cause category, such as coding, documentation, query, or system error.

Reasonable Benchmark Ranges

Appropriate benchmarks vary by organization type and case mix, but many high performing hospitals and large physician groups operate within these general ranges:

• Overall DNFB age for inpatient cases: 3 to 5 days for most accounts, with a small percentage of high complexity cases allowed to age slightly longer.

• Overall DNFB age for outpatient and professional claims: 1 to 3 days for the majority of encounters.

• DNFB dollars older than 10 days: ideally fewer than 5 to 7 percent of total DNFB dollars, with clear action plans for exceptions.

Benchmarks should not be applied blindly. Instead, use them as directional targets and adjust based on your staffing model, payer mix, and system capabilities. What matters most is a consistent trend toward lower age and fewer outliers.

Governance, Accountability, and Culture Around DNFB

Technical fixes and new reports will not sustain DNFB improvement unless there is a governance structure that defines who owns what, how performance is reviewed, and how issues are resolved quickly.

Create a Cross Functional DNFB Steering Group

A small governance group should meet regularly with participation from revenue cycle leadership, HIM, coding, clinical operations, IT, and case management. This group should:

• Review DNFB metrics by service line and reason code.

• Identify emerging problem areas, such as a spike in documentation related DNFB in one department.

• Assign owners and timelines for resolving systemic issues, for example, EHR configuration changes or provider training sessions.

These meetings do not need to be long, but they must be consistent. Even a 30 minute weekly huddle can be effective if the report is structured well and the participants are empowered to make decisions.

Push Accountability to the Service Line Level

DNFB is often perceived as a back office metric. That perception needs to change. Service line directors and physician leaders should see DNFB performance for their areas just as they see clinical quality and productivity indicators.

Practical approaches include:

• Providing monthly and quarterly DNFB scorecards to each service line, including comparisons against organizational averages.

• Recognizing high performing departments that maintain low DNFB age and few documentation related delays.

• Embedding DNFB related expectations into provider onboarding and ongoing education, especially for high impact activities such as operative note completion.

When clinical and operational leaders view DNFB as part of their responsibility, improvements become durable rather than dependent on a few revenue cycle champions.

Protecting Revenue and Cash Flow by Getting Ahead of DNFB

Uncontrolled DNFB quietly eats away at financial performance. It pushes revenue recognition into the future, increases the likelihood of missing payer filing deadlines, and masks underlying operational problems in documentation and coding. In a margin pressured environment, few organizations can afford that kind of leakage.

By redesigning your DNFB report, diagnosing true root causes, embedding preventive workflows, and governing performance at both the executive and service line level, you can turn DNFB from a frustrating backlog into a tightly managed part of your revenue cycle. The payoff shows up quickly in more predictable cash, fewer avoidable denials related to late or incomplete documentation, and better visibility into how each department contributes to the financial health of the organization.

If your DNFB report currently feels more like a list of unsolved problems than a management tool, it may be time to re evaluate your approach. A focused review of your DNFB structure, metrics, and workflows can reveal rapid, low capital opportunities to improve cash and reduce risk.

Need help turning your DNFB report into an engine for faster, cleaner billing? You can connect with a revenue cycle expert to review your current DNFB performance and identify specific workflow and analytics improvements tailored to your organization. Contact us to start a focused DNFB assessment and begin moving more of your discharges to cash, faster.

References

Healthcare Financial Management Association. (n.d.). Key performance indicators for revenue cycle management. Retrieved from https://www.hfma.org